CAJ | 학술논문

目的分析早期巨块型宫颈癌复发和(或)转移的临床特点、影响因素及生存情况.方法 2000年1月1日至2009年12月31日间收治的345例Ⅰb2期和Ⅱa2期巨块型宫颈癌患者中,复发和(或)转移者76例,分析其临床特点、复发时间、复发部位、复发相关因素、复发后治疗及生存情况.结果全组复发和(或)转移率为22.0％,＜1年、1～2年、3～5年和＞5年的复发和(或)转移率分别为38.2％、27.6％、30.3％和3.9％.局部复发率、远处转移率、局部复发合并远处转移率分别为57.9％、26.3％和15.8％,局部复发、远处转移、局部复发合并远处转移患者的5年生存率分别为34.5％、23.6％和11.1％(P=0.555).复发和(或)转移后采用手术±化疗、放疗±化疗和单纯化疗治疗的患者5年生存率分别为53.3％、30.7％和24.6％ (P =0.686).单因素分析显示,临床分期、淋巴结转移、宫颈间质侵犯深度、脉管瘤栓、病理类型与早期巨块型宫颈癌的复发和(或)转移相关.多因素分析显示,淋巴结转移、脉管瘤栓和病理类型是影响早期巨块型宫颈癌复发和(或)转移的主要因素.通过对局部复发和远处转移两个亚组的分析显示,淋巴结转移和临床分期是影响早期巨块型宫颈癌局部复发的主要因素,病理类型、脉管瘤栓和淋巴结转移是影响早期巨块型宫颈癌远处转移的主要因素.结论早期巨块型宫颈癌的复发和(或)转移多出现在治疗后2年内,淋巴结转移患者的局部复发和远处转移率明显增加,非鳞癌及脉管瘤栓阳性患者更易发生远处转移.新辅助化疗未能减少早期巨块型宫颈癌的局部复发和远处转移的发生.复发后的治疗可采用个体化的治疗方式.
목적 분석조기거괴형궁경암복발화(혹)전이적림상특점、영향인소급생존정황.방법 2000년1월1일지2009년12월31일간수치적345례Ⅰb2기화Ⅱa2기거괴형궁경암환자중,복발화(혹)전이자76례,분석기림상특점、복발시간、복발부위、복발상관인소、복발후치료급생존정황.결과 전조복발화(혹)전이솔위22.0％,＜1년、1～2년、3～5년화＞5년적복발화(혹)전이솔분별위38.2％、27.6％、30.3％화3.9％.국부복발솔、원처전이솔、국부복발합병원처전이솔분별위57.9％、26.3％화15.8％,국부복발、원처전이、국부복발합병원처전이환자적5년생존솔분별위34.5％、23.6％화11.1％(P=0.555).복발화(혹)전이후채용수술±화료、방료±화료화단순화료치료적환자5년생존솔분별위53.3％、30.7％화24.6％ (P =0.686).단인소분석현시,림상분기、림파결전이、궁경간질침범심도、맥관류전、병리류형여조기거괴형궁경암적복발화(혹)전이상관.다인소분석현시,림파결전이、맥관류전화병리류형시영향조기거괴형궁경암복발화(혹)전이적주요인소.통과대국부복발화원처전이량개아조적분석현시,림파결전이화림상분기시영향조기거괴형궁경암국부복발적주요인소,병리류형、맥관류전화림파결전이시영향조기거괴형궁경암원처전이적주요인소.결론 조기거괴형궁경암적복발화(혹)전이다출현재치료후2년내,림파결전이환자적국부복발화원처전이솔명현증가,비린암급맥관류전양성환자경역발생원처전이.신보조화료미능감소조기거괴형궁경암적국부복발화원처전이적발생.복발후적치료가채용개체화적치료방식.
Objective To analyze the clinical characteristics,influencing factors and outcome of recurrent patients with early stage bulky cervical carcinoma.Methods Between January 1st 2000 and December 31st.2009,76 patients with stage Ⅰ b2 and Ⅱ a2 bulky cervical carcinoma developed recurrence and (or) metastasis.The recurrence time,recurrence location,recurrence-related factors,treatment and survival were analyzed.Results The median follow up was 44 months ( 9-137 months).The overall recurrence and (or) metastasis rate was 22.6％.The 1-,1-2,3-5 and 5-year recurrence and (or) metastasis rates were 38.2％,27.6％,30.3％ and 3.9％,respectively.The 5-year survival rate of local recurrence was 34.5％,that of distant metastasis was 23.6％,and that of distant metastasis with synchronous pelvic recurrence was 1 1.1％,( P =0.555 ).The 5-year survival rate of patients who received surgery plus chemotherapy,radiation plus chemotherapy and chemotherapy alone after recurrence and (or) metastasis were 53.3％,30.7％ and 24.6％,respectively ( P =0.686 ).Univariate analysis demonstrated that tumor recurrence and (or) metastasis in patients of the stage Ⅰ b2 and Ⅱ a2 bulky cervical carcinoma were influenced by the disease stage,pelvic lymph node metastasis,deep cervical stromal invasion,lymphovascular tumor thrombus and pathological types.Multivariate regression analysis demonstrated that pelvic lymph node metastasis,lymphovascular tumor thrombus and pathological types were the key factors affecting the recurrence and (or) metastases of the stage Ⅱ b2 and Ⅱ a2 bulky cervical carcinoma.Subgroup analysis showed that pelvic lymph node metastasis and stage were the main factors affecting the local recurrence in those patiens,and the pathological type,vascular tumor thrombus and pelvic lymph node metastasis were the main factors affecting the distant metastasis.Conclusions Recurrence and (or) metastasis of early stage bulky cervical cancer are mostly happened within 2 years post operation.Patients with pelvic lymph node metastasis have high probability to develop local recurrence and distant metastasis.Patients with non-squamous cell carcinoma and lymphovascular tumor thrombus are more likely to develop distant metastasis.Neoadjuvant chemotherapy does not decrease local recurrence and distant metastasis in patients with stage Ⅰ b2 and Ⅱ a2 bulky cervical carcinoma.Individualized treatment is advised for recurrent patients.